Comparative Efficacy of Local and General Anesthesia for Transcatheter Aortic Valve Implantation: A Meta-Analysis and Systematic Review
DOI:
https://doi.org/10.1532/hsf.4631Keywords:
meta-analysis, transcatheter aortic valve implantation, general anesthesia, local anesthesia, aortic stenosisAbstract
Background: This meta-analysis aimed to compare the potential effects of local anesthesia (LA) and general anesthesia (GA) for transcatheter aortic valve implantation (TAVI).
Measurements: All relevant studies were searched from Pubmed, EMbase, Web of Science, and the Cochrane Library (January 1, 2016, to June 1, 2021). The main outcomes of this literature meta-analysis were 30-day mortality, procedural time, new pacemaker implantation, total stay in the hospital, use of the vasoactive drug, and intra-and postoperative complications and emergencies, including conversion to open, myocardial infarction, pulmonary complication, vascular complication, renal injury/failure, stroke, transesophageal echocardiography, life-threatening/major bleeding, cardiac tamponade, and emergency PCI. Pooled risk ratio (RR) and mean difference (MD) together with a 95% confidence interval (CI) were calculated.
Results: A total of 17 studies, including 20938 patients, in the final analysis, fulfilled the inclusion criteria. Intra-and postoperative complications (myocardial infarction, vascular complication, renal injury/failure, stroke, and cardiac tamponade) undergoing TAVI in severe AS patients under GA do not offer a significant difference compared with LA. No differences were observed between LA and GA for new pacemaker implantation, total stay in the hospital, transesophageal echocardiography, and emergency PCI. LA has lower mortality compared with GA (RR 0.69, P = 0.600), pulmonary complications (RR 0.54, P = 0.278), life-threatening/major bleeding (RR 0.85, P = 0.855), and lower times of conversion to open (RR 0.22, P = 0.746). LA has many advantages, including a shorter procedure duration (MD=-0.38, P = 0.000) and reduction of the use of the vasoactive drug (RR 0.57, P = 0.000).
Conclusions: For TAVI, both LA with or without sedation and GA are feasible and safe. LA appears a feasible alternative to GA for AS patients undergoing TAVI.
References
Babaliaros V, Devireddy C, Lerakis S, et al. 2014. Comparison of transfemoral transcatheter aortic valve replacement performed in the catheterization laboratory (minimalist approach) versus hybrid operating room (standard approach): outcomes and cost analysis. JACC Cardiovasc Interv. 7(8):898-904.
Bartel T, Edris A, Velik-Salchner C, Muller S. 2016. Intracardiac echocardiography for guidance of transcatheter aortic valve implantation under monitored sedation: a solution to a dilemma? Eur Heart J Cardiovasc Imaging. 17(1):1-8.
Ben-Dor I, Looser PM, Maluenda G, et al. 2012. Transcatheter aortic valve replacement under monitored anesthesia care versus general anesthesia with intubation. Cardiovasc Revasc Med. 13(4):207-210.
Bonow RO, Carabello BA, Chatterjee K, et al. 2008. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 52(13):e1-142.
Brecker SJ, Bleiziffer S, Bosmans J, et al. 2016. Investigators AS: Impact of Anesthesia Type on Outcomes of Transcatheter Aortic Valve Implantation (from the Multicenter ADVANCE Study). Am J Cardiol. 117(8):1332-1338.
Cuadrado Garcia AM, Hernandez Antolin RA, Almeria Valera C, Lopez Timoneda F. 2016. Anaesthetic management of percutaneous aortic valve implants: Results of 100 cases. Rev Esp Anestesiol Reanim. 63(8):451-458.
D'Errigo P, Ranucci M, Covello RD, et al. 2016. Outcome After General Anesthesia Versus Monitored Anesthesia Care in Transfemoral Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth. 30(5):1238-1243.
Debry N, Delhaye C, Azmoun A, et al. 2016. Transcarotid Transcatheter Aortic Valve Replacement: General or Local Anesthesia. JACC Cardiovasc Interv. 9(20):2113-2120.
Durand E, Borz B, Godin M, et al. 2012. Transfemoral aortic valve replacement with the Edwards SAPIEN and Edwards SAPIEN XT prosthesis using exclusively local anesthesia and fluoroscopic guidance: feasibility and 30-day outcomes. JACC Cardiovasc Interv. 5(5):461-467.
Ehret C, Rossaint R, Foldenauer AC, et al. 2017. Is local anaesthesia a favourable approach for transcatheter aortic valve implantation? A systematic review and meta-analysis comparing local and general anaesthesia. BMJ Open. 7(9):e016321.
Frohlich GM, Lansky AJ, Webb J, et al. 2014. Local versus general anesthesia for transcatheter aortic valve implantation (TAVR)--systematic review and meta-analysis. BMC Med. 12:41.
Greif M, Lange P, Nabauer M, et al. 2014. Transcutaneous aortic valve replacement with the Edwards SAPIEN XT and Medtronic CoreValve prosthesis under fluoroscopic guidance and local anaesthesia only. Heart. 100(9):691-695.
Guarracino F, Baldassarri R. 2016. The Anesthetic Management of Transcatheter Aortic Valve Implantation. Semin Cardiothorac Vasc Anesth. 20(2):141-146.
He W, Huang RR, Shi QY, Liu XB, Wang JA, Yan M. 2017. Bispectral index-guided sedation in transfemoral transcatheter aortic valve implantation: a retrospective control study. J Zhejiang Univ Sci B. 18(4):353-359.
Holmes DR, Jr., Mack MJ, et al. 2012. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol. 59(13):1200-1254.
Hozo SP, Djulbegovic B, Hozo I. 2005. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 5:13.
Husser O, Fujita B, Hengstenberg C, et al. 2018. Conscious Sedation Versus General Anesthesia in Transcatheter Aortic Valve Replacement: The German Aortic Valve Registry. JACC Cardiovasc Interv. 11(6):567-578.
Hyman MC, Vemulapalli S, Szeto WY, et al. 2017. Conscious Sedation Versus General Anesthesia for Transcatheter Aortic Valve Replacement: Insights from the National Cardiovascular Data Registry Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Circulation. 136(22):2132-2140.
Jabbar A, Khurana A, Mohammed A, Das R, Zaman A, Edwards R. 2016. Local Versus General Anesthesia in Transcatheter Aortic Valve Replacement. Am J Cardiol. 118(11):1712-1716.
Joint Task Force on the Management of Valvular Heart Disease of the European Society of C, European Association for Cardio-Thoracic S, Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H, Borger MA, Carrel TP, et al. 2012. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 33(19):2451-2496.
Kesimci E, Erkilic E, Gumus T, Kanbak O. 2016. Impact of different anesthetic managements in outcomes of transcatheteraortic valve implantation: the first Turkish experience. Turk J Med Sci. 46(3):742-748.
Kiramijyan S, Ben-Dor I, Koifman E, et al. 2016. Comparison of clinical outcomes with the utilization of monitored anesthesia care vs. general anesthesia in patients undergoing transcatheter aortic valve replacement. Cardiovasc Revasc Med. 17(6):384-390.
Landis JR, Koch GG. 1977. The measurement of observer agreement for categorical data. Biometrics. 33(1):159-174.
Liberati A, Altman DG, Tetzlaff J, et al. 2009. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 6(7):e1000100.
Martins A, Castro ML, Fragata I. 2019. [Initial Experience of a TAVI Program: Analysis of the Anesthetic Decision and its Evolution]. Acta Med Port. 32(2):126-132.
Mayr NP, Hapfelmeier A, Martin K, et al. 2016. Comparison of sedation and general anaesthesia for transcatheter aortic valve implantation on cerebral oxygen saturation and neurocognitive outcomedagger. Br J Anaesth. 116(1):90-99.
Miles LF, Joshi KR, Ogilvie EH, et al. 2016. General anaesthesia vs. conscious sedation for transfemoral aortic valve implantation: a single UK centre before-and-after study. Anaesthesia. 71(8):892-900.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. 2010. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 8(5):336-341.
Nishimura RA, Otto CM, Bonow RO, et al. 2014. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 63(22):2438-2488.
Palermo C, Degnan M, Candiotti K, Salerno T, de Marchena E, Rodriguez-Blanco Y. 2016. Monitored Anesthesia Care Versus General Anesthesia: Experience With the Medtronic CoreValve. J Cardiothorac Vasc Anesth. 30(5):1234-1237.
Pani S, Cagino J, Feustel P, et al. 2017. Patient Selection and Outcomes of Transfemoral Transcatheter Aortic Valve Replacement Performed with Monitored Anesthesia Care Versus General Anesthesia. J Cardiothorac Vasc Anesth. 31(6):2049-2054.
Stragier H, Dubois C, Verbrugghe P, Jacobs S, Adriaenssens T, Rex S. 2019. General Anesthesia Versus Monitored Anesthesia Care for Transfemoral Transcatheter Aortic Valve Implantation: A Retrospective Study in a Single Belgian Referral Center. J Cardiothorac Vasc Anesth. 33(12):3283-3291.
Thiele H, Kurz T, Feistritzer HJ, Marquetand C, Nef H, Doerr O, et al. 2020. General Versus Local Anesthesia With Conscious Sedation in Transcatheter Aortic Valve Implantation: The Randomized SOLVE-TAVI Trial. Circulation. 142(15):1437-1447.
Villablanca PA, Mohananey D, et al. 2018. Comparison of local versus general anesthesia in patients undergoing transcatheter aortic valve replacement: A meta-analysis. Catheter Cardiovasc Interv. 91(2):330-342.
